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PMI Phleb Final
PMI Phleb Final (Ch 7-10)
| Question | Answer |
|---|---|
| What is aliquot? | Aliquot is a portion of a specimen being tested. |
| What angle is the spreader slide? | 45 degrees |
| What temp should be unused evacuated tubes be stored at? | 4-25 degrees C |
| What is the best practice if the vein can be felt, but not seen even with a tourniquet on? | Look for visual clues on the skin (freckles, scars, etc.) |
| What is another name for a butterfly? | Winged infusion set |
| Why should the thumb not be used to feel for an artery? | Because the thumb has a pulse |
| All of the following specimen need to be centrifuged except: | CBC in a lavender (2 reasons why wouldn't be spun is not a clotter tube, potassium doesn't go in a heparin tube) |
| Needles are color coded by their? | Gauge |
| What is most important consideration when drawing blood from an older child? | Explaing the importance of holding still |
| Which anticoagulant prevent coagulation by inhibiting thrombin? | Heparin |
| It is better to use gauze and not cotton balls for pressure because cotton balls are: | Pull up platelets |
| Which of the following can be a complication resulting from deep skin punctures to an infant's heel? | Osteochrondritis |
| What is some general criteria to consider for selecting a skin puncture site? | Warm pink site |
| The type of care for someone who is terminally ill is known as: | Hospice |
| Which of the following is acceptable angle for ABG? | 45 degrees |
| Two part of a syringe is the graduate barrel and ? | The plunger |
| Where is the tourniquet applied when drawing a hand vein? | Proximal to the wrist bone |
| The most likely reason a phlebotomist would wrap a specimen in foil? | To protect it from light |
| Which additive prevent glycolosis? | Sodium Fluoride (NaF) |
| What is the preferred site for an arterial puncture? | Radial artery |
| A glucose specimen in a sodium fluoride tube is stable at room temp for ? | 24 hours |
| What is a most common, direct, efficient and preferred system for collecting blood systems? | Evacuated tube system |
| The composition of skin punctured blood looks more like? | Arterial and venous blood |
| To avoid an airborne infection while processing a specimen you should? | Use the stopper remover or cover the stopper with guaze |
| If a patient adamantly refuses to have their blood drawn you should? | Notify the nurse and fill out a failure to obtain specimen |
| What is the max amt of time a tourniquet can be left on before you have hemolysis? | 1 minute |
| Why is skin puncture blood sometimes called capillary blood? | It's obtained from the capillary beds |
| Why should serum tubes be transported with the stopper in the up direction? | Aides in clot formation, reduces aggregation and prevents contents from coming in contact with the stopper |
| Approx how long does it normally take a serum specimen to clot completely at room temperature? | 30-60 minutes |
| The color code that is most often associated with hematologic test is? | Lavender |
| What should be done if a pt is still bleeding 10 minutes after checking the site? | Notify the pt nurse/physician |
| When performing venipuncture hand washing is necessary: | Before and after each pt |
| Why is it recommended to use several layer of gauze during needle removal? | To prevent the gloves from being contaminated with blood |
| If you have an inpatient and they are not wearing an id band when you go to collect the specimen you hsould: | Ask the patients nurse to put on an armband before drawing blood |
| Why should a phlebotomist visually inspect the needle tip before inserting it into the patients veing? | To check for imperfections |
| Labeling a routine blood specimen should take place: | At the bedside immediately after collection |
| What is the best angle for needle insertion? | 15-30 degrees |
| What is the recommended skin puncture site on children 2 years of age or older? | The fleshy portion of the middle finger |
| According to CLSI guidelines when is the best time to remove a tourniquet? | As soon as blood flow is in the tube |
| Which of the following sites would be eliminated as a skin puncture site? | An edemos or edematous extremity |
| It is important to mix anticoagulant tubes immediately after filling them to: | Avoid micro clot formation |
| A skin puncture that parallels whorls of the fingerprint will: | Allow the blood to roll down the finger |
| How many times must you mix non additive tubes | 0 - zero |
| According to OSHA what does proper needle disposal involve? | Disposing of the needle and the needle hold as one unite |
| Which of the following is not proper skin puncture procedure? | Using provodone iodine |
| According to CLSI the maximum time from separating serum or plasma from cells is? | 2 hours |
| It is suggested that additive tubes be gently inverted how many times as soon as they are drawn: | 3-8 times |
| OOD for ETS | Sterile yellow/BC bottles, Lt blue (FULL), Red, SST, PST Lt green, Green, Lavender, Grey |
| OOD for Syringe | Sterile yellow/BC bottles, Lt blue (full), PST Lt green, Green, Lavender, Grey, Red, SST |
| Needle gauge size/color | Pink - 18', Yellow - 20', Green - 21', Black - 22', Lt blue - 23' butterfly, Dk blue - 25' butterfly |
| When palpating what 3 things are we looking for? | Size of vein, depth of vein, direction of vein |
| Name 3 things that cause hemolysis: | Tourniquet time (1 min or less), Butterfly tube, Pt pumping/clenching fist, Wrong size needle, Shaking tubes, Excess heat, Long transport time, Pushing/pulling too fast on syringe, Not allowing antiseptic to dry completely |
| Tourniquet restrict arterial flow & allow venous? True or false | False; tourniquet restrict venous flow & allow arterial flow |
| Abbreviation for the collections system typically used for routine venipuncture? | ETS |
| Additive that prevents the breakdown of glucose by the cells | Antiglycolytic agent |
| Additive used for immunohematology tests such as DNA and HLA typing | ACD |
| Anticoagulant that inhibits the formation of thrombin | Heparin |
| Anticoagulant that preserves cell shape and structure and inhibits platelet clumping | EDTA |
| Breakdown or metabolism of glucose by blood cells | Glycolysis |
| Coagulation-enhancing substance such as silica | Clot activator |
| End of the needle that attaches to the blood collection device | Hub |
| Number that is related to the diameter of the needle lumen | Gauge |
| Point of a needle that is cut on a slant for ease of skin entry | Bevel |
| Premeasured vacuum tube that is color-coded based on its additive | Evacuated tube |
| Solutions used to kill microorganisms on surfaces and instruments | Disinfectants |
| Substance added to blood collection tube | Additive |
| Substance that prevents blood from clotting | Anticoagulant |
| Substances used for skin cleaning that inhibit the growth of bacteria | Antiseptics |
| Winged infusion blood collection set | Butterfly needle |
| Additive used in blood culture collection | SPS |
| Anticoagulant commonly used to preserve coagulation factors | Sodium citrate (NaC) |
| Anticoagulant commonly used with an antiglycolytic agent | Potassium oxalate (KOx) |
| Butterfly needle | Winged infusion set |
| Clot activator | Silica |
| Gel tube for separation of cells and serum | SST |
| Heparinized gel tube for separation of cells and plasma | PST |
| Internal space of a vessel or tube | Lumen |
| Long cylindrical portion of a needle | Shaft |
| Most common antiglycolytic agent | Sodium fluoride (NaF) |
| Special puncture-resistant leak-proof disposable container | Sharps container |
| Special sequence in which tubes are filled during a multiple-draw | Order of draw |
| Synthetic substance used to separate cells from serum or plasma | Thixotropic gel |
| Type of needle used to collect several tubes during a single venipunture | Multisample needle |
| Type of needle used when collecting blood with a syringe | Hypodermic needle |
| Anticoagulants (7) | ACD, CPD, EDTA, Heparin, Potassium oxolate (KOx), Sodium citrate (NaC), SPS |
| Antiglycolytic agent | Sodium fluoride (NaF) |
| Clot activator | Silica |
| Serum/plasma separator | Thixotropic gel |
| Binds calcium (3) | Citrate, EDTA, Potassium oxalate |
| Enhances coagulation | Silica |
| Inhibits thrombin | Heparin |
| Physical barrier | Thixotropic gel |
| Preserves glucose | Sodium fluoride (NaF) |
| An antiglycolytic agent: | Prevents the breakdown of glucose |
| Sharps containers do not have to be: | Recycable |
| Which substance would be the best thing to use to disinfect a blood spill on a lab counter-top prior to cleanup? | 1:10 dilution of bleach |
| This needle is standard needle for routine venipuncture | 21 gauge |
| What would be the best choice of equipment for drawing a small hand vein? | 23 gauge butterfly and ETS holder |
| Which of the following equipment is required in collecting blood by syringe? | Transfer device |
| Which anticoagulant prevents coagulation by inhibiting thrombin formations? | Heparin |
| What tube would typically be used to collect plasma for a stat chemistry specimen? | Green-top (lithium) |
| EDTA is a(n) | Anticoagulant |
| A light blue topped tube is most associated with what department? | Coagulation |
| Which tube is filled 2nd from a syringe according to CLSI? | Lt blue (FULL) |
| PST contains? | Heparin and gel |
| For which tube is the blood to additive ratio most important? | Lt blue (FULL) |
| Which additive provides a physical barrier to prevent glycolysis? | Sodium fluoride (NaF) |
| Which tube contains an anticoagulant that works by binding calcium? | Lt blue (FULL) |
| What is the purpose of a royal blue top tube? | Minimize trace-metal contamination |
| The following supplies were gathered for a routine venipuncture. Which is incorrect? A: ETS tubes B: Iodine swab C: Safety needle D: Tourniquet | A: ETS tubes |
| Which tube can be used to collect a serum specimen? | Red top |
| A tourniquet is used in venipuncture to: | Find and enter veins more easily |
| What substance do you use to clean the site of venipuncture on a pt with no known allergy to antiseptics? | 70% isopropyl alcohol |
| Which needle has the largest gauge? | 18 gauge |
| What causes evacuated tubes to fill with blood automatically? | Premeasured tube vacuum |
| Lavender top tubes are most commonly used to collect: | Hematology tests |
| A butterfly is typically used for: | Difficult and hand veins |
| A eutectic mixture of local anesthetics | EMLA |
| As soon as possible | ASAP |
| Behavior of a healthcare provider toward a pt or as perceived by a pt | Bedside manner |
| Do not resuscitate/do not attempt resuscitation | DNR/DNAR |
| Identification bracelet (abbrev) | ID band/bracelet |
| No food or drink except water for 8-12 hours | Fasting |
| Record in the order received | Accession |
| Secure firmly, as in holding a vein in place by pulling the skin taut with the thumb | Anchor |
| Series of black stripes and white paces that correspond to letters and numbers | Barcode |
| Two other names for an identification band/bracelet | Arm/wrist band |
| Type of care for terminally ill patients | Hospice |
| Backflow of blood from the tube into the vein during a draw | Reflux |
| Before an operation or surgery/after an operation or surgery | Preop/postop |
| Clinic-issued patient identification document | ID card |
| Covering or cap of a needle | Needle sheath |
| Form on which test orders are entered and sent to the lab | Requisition |
| Immediately (from Latin statim) | STAT |
| Intense fear of needles | Needle phobia |
| Medical record number used for patient ID | MR number |
| Nothing by mouth (Latin nil per os) | NPO |
| Process of verifying a patient's identity | Patient ID |
| State of being freely open | Patency |
| To examine by feel or touch | Palpate |
| Actively involve the pt in this procedure | You need to verify patient ID |
| Advise the pt to ask the nurse or physician | Pt asks for the purpose of the test |
| Ask someone to help steady the pt's arm | Unconscious pt |
| Ask the pt to remove it | Outpatient is chewing gum |
| Check the ankle after asking the pt's permission | ID band not on the pt's arm |
| Consult with the nurse or physician before proceeding | Specimen must be fasting but pt has eaten |
| Do not draw blood without pt consent | Conflicting permission statement |
| Have the most skilled phlebotomist draw the information | Needle-phobic pt |
| Make certain that the pt knows this information | You are a phlebotomy student |
| Remind the pt that the doctor needs the test results | Pt initially objects to testing |
| Detect and montor diabetes. Abnormal levels can cause confusion, seizures, or coma or lead to peripheral neuropathy. | Glucose |
| Detect inflammation; identify collagen vascular diseases | ESR |
| Determine hemoglobin levels, detect infection, and identify blood disorders | CBC |
| Determine sodium and potassium levels critical to proper nervous system function | Electrolytes |
| Diagnose kidney function disorders that may be responsible for problems such as confusion, coma, seizures, and tremors | BUN/creatine |
| Diagnose lupus and rheumatoid arthritis, which can affect nervous system function | ANA/RNA/RF |
| Identify abnormal levels associated with seizures and muscle problems | Calcium/magnesium |
| Identify protein or immune globulin disorders that can lead to nerve damage | SPEP, IPEP |
| Monitor blood-thinning medications; important in heart conditions, coagulation problems, and stroke management | PT/PTT |
| Diagnose or rule out syphilis, which can cause nerve damage and dementia | VDRL/FTA |
| A vein that has patency: | has a bounce and resilience to it |
| What type of lab requisition has been shown to decrease laboratory errors | Bar coded |
| Time is 0750 hours. You received the following test requrests on different pts. Which test specimen should you collect first? A: CBC ordered ASAP B: Cortisol ordered for 0800 C: Fasting glucose D: Postop hemoglobin | B: Cortisol ordered for 0800 |
| A student asks the pt for permission to draw blood. What answer implies that the student does not really have permission? | Yes, but I would rather not. |
| You have a request to collect a stat specimen. A doctor is with the pt when you arrive. What should you do? | Excuse yourself and politely ask the doctor for permission to do the draw. |
| You are in the process of identifying an inpatient. The pt's verbal confirmation of name and DOB matches the requisition, but the MR number is different. What should you do? | Do not collect the specimen until the problem has been addressed and resolved. |
| You are a phlebotomy student on a rotation at an outpatient site. A pt who seems extremely apprehensive about having her blood drawn tells you that she is afraid of needles. What should you do? | Ask an experience phlebotomist to perform the draw for you |
| There are 2 pts in a room. One of them has a latex allergy. You have a request to collect a blood specimen on the other one. How should you proceed? | Do not take anything that contains latex into the room. |
| The best way to judge patency of a vein is to: | Press and release it several times to determine resilience |
| What is a proper venipuncture technique? | Fill additive tubes until the vacuum is exhausted |
| What is the most critical error a phlebotomist can make? | Misidentifying a pt specimen |
| Which needle can be removed from the blood collection unit before disposal? | Syringe needle |
| When should additive tubes be mixed? | As soon as they are removed from the holder |
| You have 2 unsuccessful attempts while trying to collect an ASAP specimen on an impatient. The specimen cannot be collected by skin puncture. What should you do next? | Ask another phlebotomist to collect it. |
| The proper way to transfer blood from a syringe into an ETS tube is to: | Safely remove the needle and attach a transfer device to fill the tube |
| How can you tell that you are in a vein when drawing blood with a butterfly? | Blood usually appears in tubing |
| You are performing a venipuncture on a difficult vein using a butterfly. You have an SST and a lt blue top tube to collect. How do you proceed? | Draw a clear tube, fill and mix the lt blue, then fill and mix the SST. |
| Interventions to ease pain in collecting blood specimens from infants include: | EMLA, oral sucrose, pacifiers |
| Skin changes in elderly pts can make it hard to: | Anchor veins |
| Which type of disease is most likely to cause tremors? | Parkinson's |
| T or F: Bilirubin tests are to be protected by the light, using tin foil or amber tube | True |
| T or F: PKU tests should dry for a minimum of 3 hours, vertically | False |
| T or F: EDTA does not bind calcium | False |
| T or F: The gauge of a needle refers to the length of the needle | False |
| T or F: PTTs are analyzed in the chemistry department | False |
| T or F: A phlebotomist may "stick" a pt up to 3x maximum | False |
| T or F: When conducting a fingerstick, the lancet blade should be parallel to the pt's fingerprint | False |
| T or F: Aspirin is not considered a blood thinner because it is not a prescribed medication | False |
| T or F: ESR is not the same as a sedimentation rate | False |
| T or F: Allowing the antiseptic to dry completely can cause a specimen to be hemolyzed | False |
| T or F: Small preprinted labels are considered requisitions and/or PHI | True |
| T or F: A sheath of a needle is sometimes referred to as the "cap" or "cover" | True |
| Required information on a requisition (9) | Physician's name Pt's first & last names & middle initial Pt's MR #(inpatient) PT's DOB Room # & bed(inpatient) Type of test performed Date test performed Billing info & ICD-9 codes(outpatient) Test status(timed, fasting) Special precautio |
| A member of the clergy is with the pt when you arrive to collect a routine specimen. What should you do? | Come back after the clergy person is gone |
| You are asked to collect a blood specimen from an inpatient. The pt is not wearing an ID band. What should you do? | Ask the pt's nurse to put an ID band on the pt before you draw the specimen |
| If a pt adamantly refuses to have blood drawn you should: | Notify the pt nurse or physician and notate |
| An inpatient is eating breakfast when you arrive to collect a fasting glucose. What is the best thing to do? | Consult with the pt's nurse to see if the specimen should be collected. |
| After cleaning the venipuncture site with alcohol, the phlebotomist should: | Allow the alcohol to dry completely |
| The tourniquet should be released | As soon as blood flow is established, before needle removal from the arm, and within 1 minute of its application |
| T or F: A syringe is sometimes used for veins that collapse easily | True |
| After inserting a butterfly needle, the phlebotomist must "seat" it, meaning | Slightly thread it within the lumen of the vein |
| Blood collection tubes are labeled | Immediately after specimen collected |
| What is the best approach to use on an 8-yr-old child who needs to have blood drawn? | Explain the draw in simple terms and ask for the child's cooperation |
| Which type of pt is most likely to have an arteriovenous fistula or graft? | Dialysis |
| What is proper procedure when dealing with an elderly pt? | Make certain to hold adequate pressure after the draw until the bleeding stops |
| Peak levels of this analyte typically occur around 0800 hours? | Cortisol |
| What tests are most affected if the pt is not fasting? | Glucose & triglycerides |
| Veins that feel hard and cord-like when palpated may be | Thrombosed |
| Tiny red spots that appear on a pt's arm when the tourniquet is applied is a sign that | The site may bleed excessively |
| When the arm of the pt is swollen with excess fluids, the condition is called: | Edema |
| A pt has several short lengths of IV-type tubing protruding from his chest. This is most likely a/an: | CVC |
| What would most likely to allow reflux to occur during venipuncture? | Filling the tube stopper end-first |
| What can result in hemoconcentration? | Leaving the tourniquet on over 1 minute |
| You are in the process of collecting a specimen by venipuncture. You hear a hissing sound, there is a spurt of blood into the tube, and blood flow stops. What has most likely happened? | Tube vacuum escaped |
| What is the minimum amount of blood required for BC bottles? | 10ml, but filling is preferred |
| What is required on the BC bottle(s) label? | Pt name, Pt id#, date of collection, time of collection, phleb's initials, number of number collections, area/site of draw |
| What color is a peds BC bottle? | Pink |
| What 4 things can you NOT do during BC bottle venipuncture? | Retouch site to repalpate, redraw from same area, draw above IV site, cover bar code on bottles |
| How long is a friction scrub? | 15-30 seconds DO NOT remove from skin during scrub; if you do, start all over |
| What allergies do you need to ask about during BC bottle collection? | Latex and shellfish/iodine |
| What type of needle should be used for BC bottle(s) collection? | Always butterfly |
| What antispectic(s) is(are) used for a pt without a shellfish/iodine allergy during BC bottles collection? | Alcohol and iodine |
| What antispectic(s) is(are) used for a pt with a shellfish/iodine allergy during BC bottles collection? | Chloroprep |
Created by:
rainie529
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